Capsular contracture following breast augmentation – Surgery in Switzerland at a glance
Duration of surgery
1 to 3 hours
Rest and recovery
About 2 weeks; no sports for 6 weeks
Return to work
After around 1-2 weeks
Swelling, redness, bruising, changes in sensitivity, arm mobility limitations
How does capsular contracture develop?
After a certain amount of time, the human body forms a “capsule” of tissue around every foreign object—a normal defensive reaction that happens with all implants, from artificial hips to breast implants. The difference between these two types of implants is that the silicone implants used in breast augmentation are soft, whereas prosthetic hips are rigid. In most cases, the capsule is made of soft connective tissue, so it can neither be seen nor felt. Once in a while, however, the capsule hardens, which can deform the soft silicone implant. The reasons for this tissue hardening are not entirely clear. There are several degrees of capsular contracture, which are classified according to the Baker scale:
Normal (soft, natural-looking breast)
Mild capsular contracture (minimal hardening of the breast; no exterior changes)
Significant capsular contracture / early-stage capsular contracture (more extensive hardening of the breast, visible deformation, no pain)
Extensive capsular contracture (significant hardening of the breast, severe deformation, pain)
Preventing capsular fibrosis
Methods my clinic uses
Although the exact causes of capsular contracture are not entirely clear, several studies have indicated that it may be triggered by contamination with skin bacteria during the augmentation operation.
As such, I take great pains to keep that risk as minimal as possible. Besides bathing the implant in a special disinfectant, I insert the implant using the Keller funnel technique, a “no-touch” technique that employs a special insertion tool.
Detecting capsular contracture
Temporary changes of the breast can occur after any operation (e.g., hardening, pain). Not all of these changes are necessarily capsular contracture—the symptoms could be caused by excessive strain, for example. In case of uncertainty, always consult your treating physician, as only an expert can investigate these symptoms and make a corresponding diagnosis. Typical symptoms that may indicate capsular fibrosis include:
- Breast pain and tightness
- Visible breast deformation
- Changes in implant shape
- Implant slippage or rotation
- A hard, palpable capsule
- Sudden asymmetry
When is surgery necessary?
Capsular contracture typically requires surgery if the connective-tissue capsule around the implant hardens to the point that the changes can be both seen and felt. Grade 3 capsular contracture can sometimes be treated using non-surgical or minimally invasive methods; in our experience, it is always advisable for Grade 4 patients to undergo surgery to excise the pathological tissue and remove or replace the implant.
Your operation in Zug
As part of a thorough doctor-patient discussion, I will have you explain the symptoms you are experiencing, and then examine you thoroughly in order to confirm whether capsular contracture has developed—and if so, whether it will require surgery. If your implants need to be removed, you will need to decide whether you want them replaced.
Some women may be candidates for breast implant removal followed by autologous breast augmentation, which means enlarging the breasts using transplanted fat. I use this method often and have had excellent experiences with it. Removing implants generally results in breasts that sag or droop; the autologous fat grafting (lipofilling) method can help restore a more aesthetically pleasing shape. This procedure requires a great deal of experience as well as a keen sense of aesthetics, which is why it should only be done by an experienced plastic and cosmetic surgery specialist. The advantage of this method is that it provides beautiful, natural-looking results with no risk of recurring capsular contracture, since no foreign objects are inserted.
After thorough planning and discussion, we will schedule your surgery. On the day of your operation, you will be admitted to the clinic on an inpatient basis, and the anesthesiologist and I will meet with you to confirm that there are no contraindications to the procedure. Next, I will mark incision guidelines on your skin, and then general anesthesia will be administered for the operation itself. I will start by carefully removing the breast implants as well as the capsule. If you have decided to get new implants, I will insert them. Removal-only procedures usually take an hour or two; remove-and-replace operations usually require two to three hours.
What happens after surgery?
After your breast implants have been removed / replaced, you will remain at the clinic for one to three days; in rare cases, a longer inpatient stay may be advisable so that you can recover under medical supervision. Any surgical drains will be removed after one or two days. Initially, your primary job is to rest and recover—avoid physical exertion such as heavy lifting or exercise. You will need to wear a special compression bra (of the same type worn following breast implant surgery) for the first six weeks. To minimize strain on the scars, make sure to sleep on your back at first, not on your side or stomach. Your breasts will need to be protected from direct sunlight for around three months.
What complications can occur when treating capsular contracture?
As with breast augmentation, capsular contruacture surgery can result in swelling, redness, and bruising. Treat any pain using commercially available analgesics—I will provide recommendations and information as needed. You may experience temporary changes in sensation or feelings of tension. All of these symptoms usually subside within a few weeks. When this procedure is performed by an experienced plastic surgeon, the risk of complications is very low.
If you choose to have new implants put in, there is a risk of capsular contracture recurring, though this risk is comparatively minimal with the newest generation of breast implants.
The final results will be visible after about three to six months. If you have only had your implants removed (not replaced), it may affect the overall appearance of your breasts; for optimum results, it may be advisable to consider adding a breast lift or lipofilling to the procedure. Of course, I would be happy to advise you on your options for achieving naturally beautiful breasts after implant removal.
More info on capsular fibrosis and treatment
Do you suspect that hardened tissue has formed around your implants? Are you exploring your options after having been diagnosed with capsular fibrosis / capsular contracture? As a plastic surgery and breast surgery expert, I am here for you—I would be glad to provide thorough consultation on your medical options. To schedule your appointment, call +41 41 729 50 29 or email me at firstname.lastname@example.org.